PURPOSE: In this study, we compared the effects of constructivist and traditional teaching strategies in teaching advanced cardiac life support (ACLS) skills during simulation-based training (SBT). METHODS: A randomized, pre- and post-test control group study was designed to examine this issue in 29 third-year emergency medical technician (EMT) students. Participants received SBT through constructivist SBT (CSBT) or traditional lecture-based SBT (TSBT) teaching strategies. We evaluated the effects of the simulation training on ACLS knowledge, and performance immediately after practice and at retention. RESULTS: The knowledge and performance of the CSBT group were higher than compared with the TSBT group (mean knowledge 33.3+/-5.03 vs. 29.5+/-5.33, p=0.36; and mean performance 12.20+/-1.85 vs. 8.85+/-3.54, p=0.010). However, there was no difference between two groups in retention between groups 1 month later (mean knowledge 31.86+/-4.45 vs. 31.50+/-4.65, p=0.825; and mean performance 12.13+/-0.99 vs. 12.57+/-1.78, p=0.283). CONCLUSION: CSBT is more effective with regard to knowledge acquisition and performance than TSBT. Further studies are needed to explore ways of improving retention and transfer of knowledge from simulated to real situations with SBT.
Advanced Cardiac Life Support ; Emergency Medical Technicians ; Humans ; Retention (Psychology)

PURPOSE: Hyperventilation during cardiopulmonary resuscitation (CPR) is common and can be detrimental to survival. We designed a method for delivery of an appropriate rate of ventilation during CPR by setting a compression numbers to ventilation ratio. METHODS: We conducted a virtual simulation trial using 12 randomly sorted actual CPR video files. Participants provided ventilation using a self-inflating bag while watching one minute of CPR video clips utilizing pre-set compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively. Ventilation rates per minute were manually calculated and analyzed. RESULTS: Eight medical doctors and eight emergency medical technician students were included. Among the three groups, significant different mean (S.D) ventilation rate per min (compression to ventilation ratio were 10:1, 12:1, and 15:1) was (9.9 (1.3) vs. 8.8 (1.0) vs. 7.2 (0.8), respectively; p<0.0001). Proportion of the number of appropriately delivered ventilations was 62.5%, 89.6%, and 38.0% for compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively (p<0.0001). CONCLUSION: Compression to ventilation ratio of 12:1 resulted in a significantly appropriate ventilation rate, compared with the ratio of 10:1 or 15:1. Pre-set compression to ventilation ratio of 12:1 seems to be a novel method for delivery of an appropriate number of ventilations during CPR after establishment of an advanced airway.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Ventilation

PURPOSE: Shorter response time is very important for critically-ill patients. The study utilized a linear planning and simulation technique to design a two-tiered system with advanced life support (ALS) ambulances. METHODS: We collected the ambulance run-sheet data from a fire department from January, 2006 to December, 2007 to determine emergency medical service (EMS) demands. The location of patient ambulance stations were mapped by geocoding and the most appropriate number and location of ambulances was calculated with the linear planning method. The planning result was validated with a discrete simulation. RESULTS: The initial enrollment was 227,377 cases of 119 calls. After geocoding, 170,472 (74.9%) cases were directly matched, 56,899 (25.0%) were indirectly matched, and (0.1%) were not matched. The latter were excluded. Using the linear planning method, the number of additional ambulances was calculated for a new two-tiered ambulance system that could achieve a 90% service level. From the current single-tiered system with 112 ambulances to a two-tiered system of 211 basic life support (BLS) units and 40 ALS units, the BLS service level for minor patients could be raised to 90%. For severely-ill patients , a BLS and ALS service level of up to 82% and 89%, respectively, service level could be achieved. The new two-tiered system was validated with the discrete simulation. After the simulation, the BLS and ALS service level for severely-ill patients reached 85% and 93%, respectively. As well, a 100% BLS service level for minor patients was achieved. CONCLUSION: Linear planning and discrete simulation with GIS data enabled the simulation of a two-tiered ambulance system that can shorten the response time of the current single-tiered system.
Advanced Cardiac Life Support ; Ambulances ; Emergencies ; Emergency Medical Services ; Fires ; Geographic Mapping ; Humans ; Reaction Time

PURPOSE: It aimed to find if written test results improved for advanced cardiac life support (ACLS) taught in flipped classroom/team-based Learning (FC/TBL) vs. lecture-based (LB) control in University of California-Irvine School of Medicine, USA. METHODS: Medical students took 2010 ACLS with FC/TBL (2015), compared to 3 classes in LB (2012-14) format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours), and 20 (12 lecture, simulation 8 hours) in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14) or podcast (2015) as was testing: 50 multiple-choice questions (MCQ), 20 rhythm matchings, and 7 fill-in clinical cases. RESULTS: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015). Two of 3 tests (MCQ and fill-in) improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.8, 96.7, P=0.0001). For the fill-in test: 94.1% for LB (89.6, 97.2) to 96.6% for FC/TBL (92.4, 99.20 P=0.0001). For MC: 88% for LB (84, 92) to 90% for FC/TBL (86, 94, P=0.0002). For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%), and 2 or 3 components (8.1% vs. 3.2%, P=0.006). Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%). CONCLUSION: A FC/TBL format for ACLS marginally improved written test results.
Advanced Cardiac Life Support* ; California* ; Choice Behavior ; Humans ; Learning* ; Students, Medical* ; United States

A primary cardiac arrest is rare in children. The usual course begins with respiratory arrest and culminates in profound bradycardia or asystole and cardiovascular collapse, so it is vitally important to quickly restore ventilation in pediatric patients(phone-fast). Children over 8 years of age follow the same sequence as adults; that is calling emergency medical services before providing rescue breathing(phone-first).
Adult ; Advanced Cardiac Life Support ; Bradycardia ; Cardiopulmonary Resuscitation* ; Child ; Emergency Medical Services ; Heart Arrest ; Humans ; Ventilation

Injuries are a major of cause of death and disability in the young. The advanced trauma management in the acute trauma cases is an important clinical practice to decrease the mortality. The Advanced Trauma Life Support (ATLS) course teaches a systematic, concise approach to the early care of the trauma patient in America. The ATLS course is vital to administering care for the injured patient in emergency department trauma rooms. The program has been adopted worldwide in over 60 countries, especially outside North America. The purpose of ATLS course is to orient physicians to the initial immediate assessment and resuscitation of the injured patient. The content and skills presented by the materials are designed to assist physicians in providing the first hour of emergency care for trauma patient. It is time to set up the guideline of advanced trauma management and adopt a standard training program which aligns more precisely with practice and needs of Korean doctors.
Advanced Trauma Life Support Care ; Americas ; Cause of Death ; Emergencies ; Emergency Medical Services ; Humans ; North America ; Resuscitation

Because of different display parameters and other factors, digital medical images present different display states in different section offices of a hospital. Based on CPI integration profile of IHE, this paper implements the consistent presentation of medical images, and it is helpful for doctors to carry out medical treatments of teamwork.
Computer Simulation ; Diagnostic Imaging ; Integrated Advanced Information Management Systems ; Medical Informatics Computing ; standards

PURPOSE: Although use of simulation for medical students in medical education has increased, little is known about factors associated with performance on advanced life support simulation. The goal of this study was to determine which educational and psychosocial factors are associated with performance of senior medical students using a simulation resuscitation model. METHODS: Fourth year medical students enrolled in the study were divided into six groups. Subjects in each group underwent training in emergency medicine for a period of two weeks. This was a consecutive study conducted from March to July of 2009. Each student underwent an advanced cardiac life support (ACLS) simulation performance test while performance was graded by two ACLS instructors who were certified by the American Heart Association. The scores of the followings were collected: basic life support (BLS) practice, personality characteristics survey, case presentation, one post-training written test, and two planned tests for the Korean Medical Licensing Examination (KMLE). RESULTS: A total of 46 students participated in the study. As measured by the post-training written test and two planned tests for the KMLE, no association was observed between ACLS performance scores and personality type, BLS skills, or medical knowledge. However, scores on case presentations showed a moderate association with ACLS performance scores: r=0.390 (p<0.01). CONCLUSION: Results of this study demonstrated an association of ACLS simulation performance with case presentations. These results support the idea that the ability to manage resuscitation is associated with aptitude for analysis and coordination of patient management. These results provide guidance that can be applied to education of medical students.
Advanced Cardiac Life Support ; American Heart Association ; Aptitude ; Education, Medical ; Emergency Medicine ; Humans ; Licensure ; Patient Simulation ; Resuscitation ; Students, Medical

Breast cancer is globally known to be the commonest cause of cancer-related deaths among women. Screening tools which include breast-self examination (BSE), clinical breast examination and mammography are well-recognised to aid the detection of breast cancer among high risk women. Thus, our study was aimed to evaluate breast cancer and BSE awareness and practice, and to perform mammography screening among women who attended community breast cancer awareness and screening programme. Methods: Data was collected cross-sectionally from 2,021 women during community services from September 2013 until December 2015. Results: Majority of the women had previously attended health education on breast cancer (56.3%) and had been taught BSE techniques (61.4%), but only 38.6% performed BSE monthly. Factors associated with regular BSE practice were older age, higher education level, being married, higher monthly income, had attended health education on breast cancer, and had been taught BSE techniques. A subset of 130 high-risk women had underwent mammography screening and majority had heterogenously dense and normal mammogram findings. Conclusion: These findings suggested that regular breast cancer awareness campaigns is needed to strengthen breast cancer knowledge and to emphasise BSE techniques. Such campaigns should target younger women and those with low socioeconomic status.
Regenerative Medicine Cluster, Advanced Medical & ; Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Penang, Malaysia. 2 Clinical Division, Advanced Medical & ; Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Penang, Malaysia

Among the deaths from trauma, 50% were dead at the scene, 30% in several hours, and 20% in a few weeks by multiple organ failure. The 30% occurring in several hours may be saved with rapid assessment and management of injuries. Trauma deaths could be reduced through an organized trauma system and standardized and systemic approach by physicians involved in the initial assessment and management of trauma. This is likely to present emergent and general traumatic care to increase the ability of treating trauma patients on the base of Advanced Trauma Life Support (ATLS) by the American College of Surgeons (ACS). Thus, both legal and systemic reform with an establishment of trauma centers or use of the ATLS program in intra-hospital trauma team is necessary to maximize operation of the medical team. Introduction of and emphasis on the skill oriented ATLS program in the medical school curriculum is also needed to prepare for real situations rather than knowledge-orientated education.
Advanced Trauma Life Support Care* ; Curriculum ; Education ; Humans ; Multiple Organ Failure ; Resuscitation ; Schools, Medical ; Trauma Centers ; Triage